Case Study in Reducing the Use of Restraint

One year after receiving Maybo training to enhance knowledge and confidence in dealing with potentially violent situations and to give alternative strategies when dealing with challenging and violent situations, staff at Pastoral Cymru, leading independent provider of specialist mental health services in Wales and the South West of England, completed a questionnaire. The results showed a clear change in staff attitudes about using restraint and a significant shift towards effective de-escalation and use of alternatives to physical interventions.

Key responses:

99% of respondents said the training had improved their ability to prevent conflict and choose alternatives to physical intervention

77% of respondents, to whom it was applicable, replied that the frequency of their use of physical intervention as a means of managing challenging behaviour had reduced since training

98% thought the training had helped them to understand the needs and behaviours of service users 

99% replied that the training had helped them handle challenging behaviour and violence by being able to defuse and calm conflict

99% said the training had helped them in terms of understanding and reducing restraint related risks to patients

Reviewing the Risks

A starting point for designing a programme that is relevant to staff and meets the required training outcomes, in this case giving staff the knowledge and skills to enable them to prevent and manage challenging and violent situations, is a review of the risks.  Maybo examined existing Patoral Cymru risk assessments, policy and guidance, incident data (injuries, use of force, restraint), behavioural review, staff perceptions and patient feedback.  Interpretation of the information gathered enabled learning needs and skills gaps to be identified. This in turn informed training levels, training focus and appropriate scenarios.

The method of learning has an impact on the outcome and the quality and quantity of information that learners retain.  When possible and practicable Maybo favours training in the workplace situation, using equipment such as beds, chairs and other aids that staff need to negotiate to administer patient care. To meet the specialist needs of staff and service users at Pastoral Cymru four day face to face direct delivery training from a Maybo specialist trainer was agreed as the most appropriate and effective way to provide learning.  Time and opportunity for practice is built into the sessions and over the four consecutive days the trainer and group members build a rapport and create a safe environment to ask questions, problem solve and give focused coaching for specific scenarios. Training at this level has an impact on resources which requires commitment from managers to schedule, but results have shown the time spent in training has proven to be of value for individuals and the organisation.  

To roll out the training an intensive delivery schedule over two months was agreed to maintain focus and momentum. The speed of delivery supported team building; because many staff were trained within a short timescale they were signed onto using the new approach, skills and techniques at more or less the same time, this meant they could work effectively together and embed the learning more readily.

Monitoring Progress

Line manager buy in and observation helped establish the training into regular practice. Close monitoring of incidents and instances in which restraint was used, enabled progress to be assessed and any changes to training scenarios, or techniques made accordingly.

Refreshing Learning

Annual two day refresher sessions are built into the learning model to meet BILD (British Institute For learning Disabilities) requirements and to ensure staff received regular knowledge and skills updates. Refreshers also provide opportunity for staff to feedback what works well and where further training or different skill sets may be needed to meet changing requirements in the daily working environment.

To evaluate the effectiveness of the programme and compare staff levels of knowledge, skills and confidence in being able to manage and defuse conflict and potentially violent situations before and after the training, pre and post course questionnaires were completed. To gain a truer picture of the usefulness of the training and the extent to which it was put into practice, the post course questionnaire was completed one year on from the training. The results are positive and demonstrate an increase in staff confidence, ability to assess situations before rushing in, use alternatives to physical interventions and reduce the use of restraint.

Key delegate learning:

Better understanding of service user needs

Effective use of de-escalation techniques

Reduced need for physical interventions

Key success factors:

Thorough review of the risks

Relevant training content and context

Buy in throughout the organisation

Monitoring, review and refresher training

What the delegates say about the training….

I take time to calmly analyse the situation and not only observe and respond to the patients’ behaviour but modify my own

The Maybo training has increased my awareness of how to try and defuse situations before they reach the level where physical intervention is required

Focus on communication and preventing the situation from escalating, reducing the need for physical intervention

I found since using Maybo techniques there has been less need for physical intervention. Most people are using effective de-escalation techniques

Maybo training teaches more on managing challenging situations without having to use physical interventions

The training teaches dealing with conflict in a less confrontational way and this leads to less restraint

The techniques are more explained, less complicated and simpler to follow. Maybo techniques work better

I have a lot more confidence in my ability to manage a situation should it occur and also in a safe way for myself, my co- workers and the patient